Fast Relief For Back Pain

By Ian K. Smith, M.D.

If you suffer from persistent aches and pains in your lower back, it may be of small comfort to know you're not alone. As many as 80% of adults in the U.S. experience significant lower-back pain at some time during their life, making it second only to the common cold as a cause of lost workdays among those under age 45. The good news is that most cases aren't serious and respond well to simple treatments such as physical therapy and over-the-counter medications. But for some patients, pain persists, making them desperate to find any means of relief.

If you're in this group, your answer could well be a new, minimally invasive procedure called nucleoplasty. In less than an hour, most patients walk out of the doctor's office--yes, walk--and are free of much of their pain. To be sure, nucleoplasty is not for everyone. According to Dr. Yung Chen, director of the Stanford Interventional Spine Center in Stanford, Calif., the ideal candidate is someone who has only a mildly herniated disk--meaning the damaged disk hasn't completely ruptured or extruded too far outside its normal confines within the spinal column.

Healthy disks are like a car's shock absorbers. A soft, gel-like substance in their center, or nucleus, helps cushion the jolts caused by simple movements like running and jumping. But for various reasons, a disk's hard, protective shell can degenerate, allowing the spongy interior to bulge out and press on spinal nerves. This can cause excruciating pain that radiates down the leg in a condition commonly called sciatica.

Nucleoplasty (literally, removing the nucleus) is aimed at relieving that pressure. Using only local anesthesia and light sedation, which allows the patient to remain awake, the doctor inserts a needle into the distended disk and is guided by an X-ray imaging system that reveals the needle's position at all times. A wandlike device is then threaded through the needle and into the disk. There it emits a burst of radio-frequency energy that heats and almost instantly vaporizes the excess tissue, providing in turn almost instant pain relief.

Although more than 2,500 nucleoplasties have already been performed (at an average cost of $5,000 to $7,000), Dr. Chen readily admits that long-term, controlled studies are still needed to judge their usefulness. Still, he's pleased with the response of his patients so far. On average, they report a 70% reduction in their pain. And within one week, most are able to begin a physical-therapy program to bolster the procedure's relieving effects.

Nucleoplasty, though less invasive than spinal surgery, is not entirely risk free. (Potential complications: bleeding, infection and nerve damage.) But without cutting, the risks are drastically reduced. And for those whose disks are only a little misaligned but still intact, nucleoplasty might finally provide some welcome relief.

Dr. Ian appears on NBC's Today show. ianmedical@aol.com